Functional and survival outcomes in elderly patients undergoing transoral robotic surgery. (December 2020)

• Record Type: Journal Article
• Authors: Philips, Ramez; Topf, Michael C.; Crawley, Meghan B.; Swendseid, Brian; Luginbuhl, Adam; Curry, Joseph; Cognetti, David
• Is Part Of: Oral oncology. Volume 111(2020)
• Publication Date: 2020-12
• Subjects: Transoral robotic surgery -- Head and neck cancer -- Elderly -- Age -- Survival -- Functional status -- Enteric feed dependence -- Squamous cell carcinoma -- Human papillomavirus -- Non-elderly; AJCC American Joint Committee on Cancer -- BMI body mass index -- CI confidence interval -- CRT chemoradiation therapy -- DFS disease-free survival -- FDA Food and Drug Administration -- FOIS Functional Oral Intake Scale -- FOSS Functional Outcome Swallowing Scale -- HPV human papillomavirus -- HR hazard ratio -- NPO nil per os -- OR odds ratio -- OS overall survival -- SCC squamous cell carcinoma -- TORS transoral robotic surgery; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2020.104954
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Elderly patients were more likely to have tube feeds at discharge. There was no difference in long-term swallowing status between age groups. There was no difference in tracheostomy tube placement and unplanned readmission. There was no difference in OS and DFS between elderly and nonelderly. Abstract: Objectives: To determine if elderly patients (≥70 years) have differences in functional and survival outcomes compared to non-elderly patients (<70 years) following transoral robotic surgery. Materials and methods: A retrospective cohort study was conducted on patients undergoing robotic surgery for head and neck cancer at a tertiary institution from 2011 to 2016. Functional status was evaluated with diet, enteric feeding status, Functional Oral Intake Scale (FOIS), tracheostomy tube placement, and unplanned readmission. Kaplan Meier method and Cox proportional hazard model were used to assess overall survival (OS) and disease-free survival (DFS) between elderly and non-elderly patients. Results: Two hundred and forty-six patients met inclusion criteria. The mean age of the cohort was 63.5 ± 9.74 years. There were 64 patients (26.0%) that were ≥70 years. Elderly patients were more likely to be discharged with enteric access (p < 0.002). As early as 3 months, there was no significant difference in need for enteric feeds, diet, or FOIS score. There was no difference in tracheostomy tube rates and unplanned readmission between both cohorts. There was no significant difference in OS and DFS between age groups when stratified by p16 status. Conclusions: Elderly patients are more likely to require perioperative enteric feeding, but 3-month, 1-year, and 2-year functional outcomes are comparable to younger patients. Survival outcomes are similar in both populations.